ACC: Shrinking Workforce Will Face Higher Demand

The United States lacks about 3,000 cardiologists, and that shortage will only get worse in the coming years, according to a nationwide study conducted by the American College of Cardiology.

“Our guess is that the deficit in cardiologists is probably going to widen and even double by the time we get to 2030 and 2050,” Dr. George Rodgers, lead author of the study and chair of the ACC Board of Trustees Workforce Task Force, said in a teleconference. “The drivers [of this deficit] are the aging of the population … and the epidemic of obesity and heart disease that follows that, along with diabetes. We feel there is going to be significant worsening there.”

Dr. Rodgers and his colleagues surveyed more than 6,000 office-based cardiology practices, more than 1,000 office-based pediatric cardiology practices, and 110 chiefs of cardiology at academic medical centers to see how many job openings were posted. The Lewin Group, a consulting firm, also projected cardiology workforce needs over the next 20 years based on data from sources including the American Medical Association Masterfile, the Association of American Medical Colleges Over 50 Survey, and the Medicare Part B analysis file. The study was funded by the ACC (J. Am. Coll. Cardiol. 2009;54: 1195–208).

“Today there is an active workforce of 24,000 cardiologists in America; the problem is, we only produce 750–800 new cardiologists every year,” said Dr. Rodgers, who is in private practice in Austin, Tex. “And we have a large portion of the workforce—43%—who are age 55 and over and who might be considering retirement.”

Health care reform is another potential confounder, he said. “We're certainly in favor of health care reform.” But if it succeeds in insuring the estimated 47 million people who now have none, “they'll have better access and create more demand.”

Greater success in treating heart disease and other ailments has increased the need for cardiovascular specialists, Dr. Janet Wright, vice president for science and quality at the college, said during the teleconference. “There has been a 29% reduction in death and disability from heart disease in last 8 years, but that also translates into more and more people managing cardiac problems in addition to other medical issues. The population is living longer but trying to manage more medications and more illnesses, and they need more doctors as well.”

The supply of cardiologists also suffers from racial and gender inequity, Dr. Rodgers said. Hispanics and African Americans make up 25% of the U.S. population, but they accounted for 10% of cardiology fellows in 2006–2007, and women make up 12% of the general cardiology workforce, the study found

Geographic maldistribution problems could be reduced by producing incentives for cardiovascular specialists to want to go to rural and inner-city areas, Dr. Rodgers said, citing financial incentives such as loan forgiveness. “Many physicians end up with debt of over $100,000 because of educational loans,” he said.

Dr. Rodgers offered the following suggestions:

▸ Increase funding for cardiology fellowship slots. “Are there not enough internal medicine residents who want to become cardiologists? That's certainly not the case—for every fellowship position in cardiology there are 1½ eligible candidates,” he said. “And of the 179 [cardiology] fellowship programs in country, most say they could certainly expand, but they don't have the funding to do it. That's a key problem we need to address with Washington.”

▸ Encourage more coordinated care. “Team care and working with nurse practitioners and physician assistants who are trained to deliver care in a cardiovascular environment,” also could ease the situation, he said. “The ACC is working on a core curriculum to supplement the training these professionals have so they can be more adept at cardiovascular care. But we also need to teach cardiologists how to work in a team care environment. That's a little bit of a paradigm shift for many, but we feel this is an underutilized approach.”

▸ Improve work-life balance. “The demand on cardiologists is tremendous—they have night call and weekend call, and they also must be available on a moment's notice to go to the hospital and open up a closed artery when someone is having a heart attack,” he said. This demand can be addressed systematically, for example by having interventional cardiologists coordinate on-call coverage, “but if your community is short with regard to interventional cardiologists, it's a problem.”

The United States lacks about 3,000 cardiologists, and that shortage will only get worse in the coming years, according to a nationwide study conducted by the American College of Cardiology.

“Our guess is that the deficit in cardiologists is probably going to widen and even double by the time we get to 2030 and 2050,” Dr. George Rodgers, lead author of the study and chair of the ACC Board of Trustees Workforce Task Force, said in a teleconference. “The drivers [of this deficit] are the aging of the population … and the epidemic of obesity and heart disease that follows that, along with diabetes. We feel there is going to be significant worsening there.”

Dr. Rodgers and his colleagues surveyed more than 6,000 office-based cardiology practices, more than 1,000 office-based pediatric cardiology practices, and 110 chiefs of cardiology at academic medical centers to see how many job openings were posted. The Lewin Group, a consulting firm, also projected cardiology workforce needs over the next 20 years based on data from sources including the American Medical Association Masterfile, the Association of American Medical Colleges Over 50 Survey, and the Medicare Part B analysis file. The study was funded by the ACC (J. Am. Coll. Cardiol. 2009;54: 1195–208).

“Today there is an active workforce of 24,000 cardiologists in America; the problem is, we only produce 750–800 new cardiologists every year,” said Dr. Rodgers, who is in private practice in Austin, Tex. “And we have a large portion of the workforce—43%—who are age 55 and over and who might be considering retirement.”

Health care reform is another potential confounder, he said. “We're certainly in favor of health care reform.” But if it succeeds in insuring the estimated 47 million people who now have none, “they'll have better access and create more demand.”

Greater success in treating heart disease and other ailments has increased the need for cardiovascular specialists, Dr. Janet Wright, vice president for science and quality at the college, said during the teleconference. “There has been a 29% reduction in death and disability from heart disease in last 8 years, but that also translates into more and more people managing cardiac problems in addition to other medical issues. The population is living longer but trying to manage more medications and more illnesses, and they need more doctors as well.”

The supply of cardiologists also suffers from racial and gender inequity, Dr. Rodgers said. Hispanics and African Americans make up 25% of the U.S. population, but they accounted for 10% of cardiology fellows in 2006–2007, and women make up 12% of the general cardiology workforce, the study found

Geographic maldistribution problems could be reduced by producing incentives for cardiovascular specialists to want to go to rural and inner-city areas, Dr. Rodgers said, citing financial incentives such as loan forgiveness. “Many physicians end up with debt of over $100,000 because of educational loans,” he said.

Dr. Rodgers offered the following suggestions:

▸ Increase funding for cardiology fellowship slots. “Are there not enough internal medicine residents who want to become cardiologists? That's certainly not the case—for every fellowship position in cardiology there are 1½ eligible candidates,” he said. “And of the 179 [cardiology] fellowship programs in country, most say they could certainly expand, but they don't have the funding to do it. That's a key problem we need to address with Washington.”

▸ Encourage more coordinated care. “Team care and working with nurse practitioners and physician assistants who are trained to deliver care in a cardiovascular environment,” also could ease the situation, he said. “The ACC is working on a core curriculum to supplement the training these professionals have so they can be more adept at cardiovascular care. But we also need to teach cardiologists how to work in a team care environment. That's a little bit of a paradigm shift for many, but we feel this is an underutilized approach.”

▸ Improve work-life balance. “The demand on cardiologists is tremendous—they have night call and weekend call, and they also must be available on a moment's notice to go to the hospital and open up a closed artery when someone is having a heart attack,” he said. This demand can be addressed systematically, for example by having interventional cardiologists coordinate on-call coverage, “but if your community is short with regard to interventional cardiologists, it's a problem.”

The United States lacks about 3,000 cardiologists, and that shortage will only get worse in the coming years, according to a nationwide study conducted by the American College of Cardiology.

“Our guess is that the deficit in cardiologists is probably going to widen and even double by the time we get to 2030 and 2050,” Dr. George Rodgers, lead author of the study and chair of the ACC Board of Trustees Workforce Task Force, said in a teleconference. “The drivers [of this deficit] are the aging of the population … and the epidemic of obesity and heart disease that follows that, along with diabetes. We feel there is going to be significant worsening there.”

Dr. Rodgers and his colleagues surveyed more than 6,000 office-based cardiology practices, more than 1,000 office-based pediatric cardiology practices, and 110 chiefs of cardiology at academic medical centers to see how many job openings were posted. The Lewin Group, a consulting firm, also projected cardiology workforce needs over the next 20 years based on data from sources including the American Medical Association Masterfile, the Association of American Medical Colleges Over 50 Survey, and the Medicare Part B analysis file. The study was funded by the ACC (J. Am. Coll. Cardiol. 2009;54: 1195–208).

“Today there is an active workforce of 24,000 cardiologists in America; the problem is, we only produce 750–800 new cardiologists every year,” said Dr. Rodgers, who is in private practice in Austin, Tex. “And we have a large portion of the workforce—43%—who are age 55 and over and who might be considering retirement.”

Health care reform is another potential confounder, he said. “We're certainly in favor of health care reform.” But if it succeeds in insuring the estimated 47 million people who now have none, “they'll have better access and create more demand.”

Greater success in treating heart disease and other ailments has increased the need for cardiovascular specialists, Dr. Janet Wright, vice president for science and quality at the college, said during the teleconference. “There has been a 29% reduction in death and disability from heart disease in last 8 years, but that also translates into more and more people managing cardiac problems in addition to other medical issues. The population is living longer but trying to manage more medications and more illnesses, and they need more doctors as well.”

The supply of cardiologists also suffers from racial and gender inequity, Dr. Rodgers said. Hispanics and African Americans make up 25% of the U.S. population, but they accounted for 10% of cardiology fellows in 2006–2007, and women make up 12% of the general cardiology workforce, the study found

Geographic maldistribution problems could be reduced by producing incentives for cardiovascular specialists to want to go to rural and inner-city areas, Dr. Rodgers said, citing financial incentives such as loan forgiveness. “Many physicians end up with debt of over $100,000 because of educational loans,” he said.

Dr. Rodgers offered the following suggestions:

▸ Increase funding for cardiology fellowship slots. “Are there not enough internal medicine residents who want to become cardiologists? That's certainly not the case—for every fellowship position in cardiology there are 1½ eligible candidates,” he said. “And of the 179 [cardiology] fellowship programs in country, most say they could certainly expand, but they don't have the funding to do it. That's a key problem we need to address with Washington.”

▸ Encourage more coordinated care. “Team care and working with nurse practitioners and physician assistants who are trained to deliver care in a cardiovascular environment,” also could ease the situation, he said. “The ACC is working on a core curriculum to supplement the training these professionals have so they can be more adept at cardiovascular care. But we also need to teach cardiologists how to work in a team care environment. That's a little bit of a paradigm shift for many, but we feel this is an underutilized approach.”

▸ Improve work-life balance. “The demand on cardiologists is tremendous—they have night call and weekend call, and they also must be available on a moment's notice to go to the hospital and open up a closed artery when someone is having a heart attack,” he said. This demand can be addressed systematically, for example by having interventional cardiologists coordinate on-call coverage, “but if your community is short with regard to interventional cardiologists, it's a problem.”